Brain Tissue Oxygen Monitoring in Neuro- critical Care

Avoidance of secondary cerebral hypoxia/ischemia is a mainstay of therapy in neurocritical care. On-line monitoring of brain tissue oxygen tension (PbtO2) enables detection of secondary brain hypoxic/ischemic insults and targeting of therapeutic interventions, such as intracranial pressure (ICP) control, cerebral perfusion pressure (CPP) augmentation, blood transfusion, and ventilation. Emerging evidence shows that compared to standard ICP/CPP management, PbtO2-directed therapy may improve outcomes of selected populations of braininjured patients. Larger prospective multicenter trials are underway to further evaluate the potential benefit of PbtO2-directed therapy. In light of recent important advances in this topic, the aim of this review is to summarize the physiology underlying PbtO2 monitoring, its main indications and clinical utility, and the potential benefit of PbtO2-directed therapy on outcome.